title: Comparing same day sputum microscopy with conventional sputum microscopy for the diagnosis of tuberculosis--Chhattisgarh, India.
abstract: BACKGROUND
  The World Health Organization (WHO) recommends same day sputum microscopy (spot-spot) in preference to conventional strategy (spot-morning) for the diagnosis of smear positive tuberculosis with the view that completing diagnosis on a single day may be more convenient to the patients and reduce pre-treatment losses to follow-up.
  
  
  METHODS
  We conducted a cross-sectional study in seven selected district level hospitals of Chhattisgarh State, India. During October 2012 - March 2013, two sputum specimens (spot-early morning) were collected from consecutively enrolled adult (≥ 18 years) presumptive TB patients as per current national guidelines. In addition, a second sample was collected (one hour after the collection of first spot sample) from the same patients. All the samples were examined by ziehl-Neelsen (ZN) microscopy. McNemar's test was used to compare statistical differences in the proportion smear positive between the two approaches (spot-spot versus spot-morning).
  
  
  RESULTS
  Of 2551 presumptive TB patients, 69% were male. All patients provided the first spot specimen, 2361 (93%) provided the second spot specimen, and 2435 (96%) provided an early morning specimen. 72% of specimens were mucopurulent in conventional strategy as compared to 60% in same day strategy. The proportion of smear-positive patients diagnosed by same day microscopy was 14%, as compared to 17% by the conventional method (p<0.001). A total of 73 (16.9%) potential cases were missed by the same day method compared to only 2 (0.5%) by the conventional method.
  
  
  CONCLUSIONS
  Same-day microscopy method missed 17% of smear-positive cases and contrary to prior perception, did not increase the proportion of suspects providing the second sample. These findings call for an urgent need to revisit the WHO recommendation of switching to same-day diagnosis over the current policy.
authors.affiliation: Office of the World Health Organization (WHO) Representative in India, WHO Country Office, New Delhi, India.
authors.forename: Priyakanta
authors.initials: P
authors.lastname: Nayak
authors.forename: Ajay M V
authors.initials: AM
authors.lastname: Kumar
authors.forename: Mareli
authors.initials: M
authors.lastname: Claassens
authors.forename: Donald A
authors.initials: DA
authors.lastname: Enarson
authors.forename: Srinath
authors.initials: S
authors.lastname: Satyanarayana
authors.forename: Debashish
authors.initials: D
authors.lastname: Kundu
authors.forename: Kshitij
authors.initials: K
authors.lastname: Khaparde
authors.forename: Tarun K
authors.initials: TK
authors.lastname: Agrawal
authors.forename: Shankar
authors.initials: S
authors.lastname: Dapkekar
authors.forename: Sachin
authors.initials: S
authors.lastname: Chandraker
authors.forename: Sreenivas Achuthan
authors.initials: SA
authors.lastname: Nair
mesh_terms: D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008853:Microscopy / Q000379:methods*; D008875:Middle Aged; D013048:Specimen Handling; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology*